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Individual

KATELIN KYSAR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
19629 NE 23RD ST, HARRAH, OK 73045-9305
(405) 454-0010
(405) 454-0030
Mailing address
19629 NE 23RD ST, HARRAH, OK 73045-9305
(405) 454-0010
(405) 454-0030

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4313
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200297560A
OK
Enumeration date
07/20/2010
Last updated
04/04/2012
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